The first sign of shingles is pain along one of the sensory nerves where the virus is active. The patient may also feel unwell with fever and headache. Occasionally, lymph nodes, small bean shaped structures under the skin, may swell up near the affected area as they are fighting infection.

Within one to three days of having pain, a red, raised, blistering rash starts in the region of the pain. There are often grouped small blisters known as vesicles, which can ooze. New lesions may continue to erupt for several days. As time progresses, the lesions crust and scab as they heal. As the VZV infection hides in the nerve cells of the spine, the rash is commonly limited to the area of the skin supplied by that nerve, rarely crossing the midline to the other side of the body. Nerve supply regions that are commonly affected include the face, neck, chest and abdomen, but any site can be affected. Occasionally, blisters can occur inside mouth, ears, around the eyes or in the genital area.

Pain and other symptoms usually subside as the rash disappears. The recovery is usually completed in 2-3 weeks in children and young adults, and within 3-4 weeks in older patients.

After resolution of the rash, the most debilitating and frequent complication of shingles is post-herpetic neuralgia, which is defined as persistent or recurrence of pain in the same area as the initial rash, more than one month after the infection. Individuals may experience a continuous burning sensation, increased sensitivity or shooting pain. The overlying skin is often numb or sensitive to touch and may result in itch. Other potential complications of shingles include eye infection, central nervous system infection, nerve palsies, neuromuscular disease including Guillain-Barré Syndrome, pneumonia, hepatitis and secondary bacterial infections. The risk of dying of shingles is very low, but post-herpetic neuralgia can be extremely uncomfortable.